Market Position Statement 2019/2021 - Adult & Children's Social Care & Health Services - Durham County Council
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Market Position Statement 2019/2021 Adult & Children’s Social Care & Health Services
Need help locating care and support? Care and support in County Durham This free online resource provides information to help you make plans now and in the future. www.durhamlocate.org.uk
Market Position Statement 2019/2021
Adult & Children’s Social Care & Health Services
Contents
Page No.
1. Welcome to Durham County Council’s Market Position Statement
a. What is the Market Position Statement for?
b. Key messages 4
2. Introduction
a. About County Durham 5
3. National Developments and Local Context 6
a. National developments
b. Local context
c. Key messages from the JSNA 7
4. Messages to the Whole Market 9
5. Market Opportunities 10-12
6. Working with Durham County Council 13
7. Messages for Providers of Care and Support to Adults 14-17
8. Messages for Providers of Care and Support to
Children and Young People’s Services 18-22
9. Messages for Providers of Public Health Services 23
10. Messages for Providers of Housing Services 24-25
11. Planned Procurements for 2019/20 and 2020/21 26
12. Abbreviations 27
Market
Opportunities
3
Welcome to Durham County Council’s
Market Position Statement
Hello and welcome to Durham County Council’s third Market Position Statement (MPS). This
document has been produced with input from a number of internal and external stakeholders
including service providers and sets out the direction of travel for Children’s and Adult Social Care,
Public Health and Housing during 2019/2021.
What is the Market Position Statement for?
The aim of the MPS is to bring together information and analysis about the local market so that
current and prospective providers understand the local context, what is likely to change and
where opportunities might arise in the future.
The MPS is for both existing and potential providers with the purpose of helping them to shape
their business plans to support the council’s vision for the future of local public health, social care
and housing markets. It will help providers to:
• Identify opportunities that they may tender for
• Develop their services to meet local need and demand
This MPS is designed as an interim document, to be used until the development of an Integrated
Health and Social Care Market Position Statement for County Durham is finalised (see Section 7 –
Messages for providers of Care and Support to adults – for more information).
Key messages for providers
Services in County Durham in the future should:
Be preventative so that people can regain independence and move away from support or on to
less intensive support.
• Be delivered in a more integrated way, with priorities aligned to improved service delivery and
outcomes across the health and social care system.
• Encourage personal and community resilience.
• Offer short term interventions where appropriate.
• Be flexible and person centred and developed with input from service users and carers.
• Be designed and implemented around individuals and their communities.
• Identify and achieve outcomes for service users and carers.
• Be developed in partnership with the council and other commissioners and providers of
service; for example health and the voluntary community sector.
I hope that you find this document accessible and useful. We plan
to refresh the ‘Planned procurements’ section on page 26 on a
quarterly basis to ensure that providers are as up to date as they
can be about future developments.
Denise Elliott
Market
Interim HeadOpportunities
of Commissioning
4
2. Introduction
About County Durham 0.5%
County Durham is a socially, economically and Increase
physically diverse area, home to over 0.5m
people in 12 main towns with over 300 smaller
settlements, many of which are former colliery Total population of County
villages. The county plays an important Durham in 2016, an increase
role in the economic success and stability of 2,400 people from 2015
of the North East, with key transport links
5.6%
(A1M) and the East Coast main line railway
running through it, providing infrastructure
vital to local employment and the regional
Projected increase
economy. Around 90% of the population lives
in the east of the county, predominately the
former Durham coalfield. The more sparsely
populated western dales form part of the Projected population in
North Pennines Area of Outstanding Natural County Durham by 2041
Beauty. (5.6% from 2016)
0.2%
Our population is changing, meaning
that County Durham will see significant
demographic changes in the future. By 2030, Projected increase
the number of children and young people
aged 0-17 is projected to increase by 0.7%
(from 2016), reversing some of the declining
trends seen prior to 2011. The number of Projected increase in
people aged over 65 is projected to increase 0-17 year olds by 2041
from almost one in five people in 2016 (20.2%) 3.9
to over one in four people (27.0%) by 2030.
%
Predictions are for a fairly stable population
trend for people with learning disabilities
Projected decrease
with a level of need requiring statutory social
of 18-64 year olds by 2041
care interventions. Whereas the number of
people with a physical disability aged between
18-64 years is expected to increase overall
by approximately 500 people by 2020. The Projected increase
number of people with a mental health need of 65+ year olds by 2041
is not expected to change significantly.
39.1
%
Projected increase
of 85+ year olds by 2041
114
Market
Opportunities %
5
3. National developments and local context
For national developments and local context Joint Strategic Needs Assessment (JSNA)
see the links below: The JSNA helps the council and the CCGs
inform the planning and improvement of local
National developments services and guides us to make the best use of
the funding in the commissioning of services
Care Act 2014
in County Durham.
Children and Families Act 2014
County Durham’s JSNA is not just about
Prevention concordat for better mental health and social care, but reflects the many
health - GOV.UK factors that can influence people’s health and
NHS five year forward view wellbeing. Locally it has provided the evidence
NHS 10 Year Plan (awaiting publication) base for the Joint Health and Wellbeing
Strategy (JHWS) and has informed the
development of the key strategies and plans,
Local Context including the Sustainable Community Strategy
County Durham Joint Strategic Needs and the Children, Young People and Families
Assessment - Durham County Council Plan.
Integrated Needs Assessment consultation
Durham Insight
- Durham County Council
Durham insight is a shared intelligence,
County Durham Joint Health and Wellbeing research and knowledge base for County
Strategy - Durham County Council Durham, informing strategic planning across
Sustainable Community Strategy - Durham Durham County Council and its partners. The
County Council aim is to provide users with an easy way to
access and share information, intelligence,
research and knowledge for deeper insights
about their local area or communities. This
resource will be developed further over the
coming months. www.durhaminsight.info
Market
Opportunities
6
Key Messages from the JSNA
• People in County Durham are living • In addition to this, locally HLE is
longer; life expectancy for both men (78.0 consistently below retirement age,
years) and women (81.4 years) has been indicating levels of ill health among the
improving over time, but the rate of this working-age population and suggesting
increase has slowed and there is still a many residents are not able to enjoy their
significant gap between the life expectancy retirement in good health. If someone is
(LE) in County Durham and the England diagnosed today with a long term health
average. condition at the age of 51 years there is still
on average 16 years of working life before
• There is also a social gradient to LE within state pension eligibility. The key point is
County Durham, where men and women that, compared to England, not only do
in the most deprived areas have a LE of people in County Durham live shorter lives,
between 7 and 8 years shorter than the but also spend a smaller proportion of their
least deprived areas. life in good health and without disability.
• It is also important to determine whether • 14.5% of County Durham school children
additional years of life are being spent have Special Educational Needs and
in good health or prolonged poor health Disabilities (SEND). That’s around 10,400
and dependency. Healthy life expectancy young people in County Durham. This
(HLE) adds a quality of life dimension to life is similar to England but statistically
expectancy. Similar to LE there is inequality significantly lower than the North East.
in healthy life expectancy between County
Durham and England, and within County • Just over one fifth of the County’s
Durham. Male and female HLE in County population is made up of people aged 65
Durham is statistically significantly lower and over.
than England but has increased slowly over
time. • Prevalence of long term conditions (such
as diabetes, coronary heart disease and
• There is also a social gradient to HLE within stroke) is significantly higher than the
County Durham, where men and women England average.
in the most deprived areas have a life
expectancy of between 13.8 and 14.5 years • Estimates suggest that nearly 7,000 people
shorter than the least deprived areas. in County Durham aged 65+ have dementia.
Projections suggest that this number
Men Women will rise to nearly 12,000 by 2035. As this
population will experience increasing levels
of morbidity this will present a significant
challenge to health and social care services.
• Estimates suggest there are around 10,000
Life expectancy children with a diagnosable mental health
(2014-16) 78.1 81.4 condition in County Durham, that’s one in
Healthy life expectancy ten people.
(2014-16) 59.1 56.7
Years in poor health 19.0 24.7
Market
Opportunities
7
• Estimates suggest that 1 in 4 adults will
experience mental health problems at any
one time (25%). For County Durham, this
represents over 100,000 people aged 18+.
• Durham has a higher rate of older people
admitted to permanent residential/nursing
care (762.7per 100,000 population) than
England (610.7 per 100,000 population).
• Evidence suggests that people are being
admitted to permanent residential care
later in life (average age 87 in 2017/18).
Length of stay seems to be decreasing (598
days in 2017/18 compared to 637 days in
2007/8).
Average Length of Stay
700 637 631 609 629
579 598
600 528 547 521 549
491
500 417
352 374
400 324 320
273 280 257 271
300 235
180
200
100
0
2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Average Average Linear (Average Linear (Average
nursing days residential days nursing days) residential days)
• In County Durham there were over 2,330
emergency admissions for falls for those
aged over 65 in 2016/17. This is statistically
significantly higher than England. Falls are
the largest cause of emergency hospital
admissions for older people, and have a
significant impact on long term outcomes
e.g. being a major factor of people moving
from their own home to long-term nursing
or residential care.
• Estimates suggest that 20% of the older
population are mildly lonely and a further
11% are intensely lonely. For County
Durham this would mean around 19,000
people aged 65+ are lonely and over 10,000
experiencing intense loneliness.
• There are approximately 59,000 adult
carers in County Durham. The number of
Market
carers aged 65+ providing unpaid care isOpportunities
set
to increase by 27.9% by 2030.
8
4. Messages to the Whole Market
Finance and funding Integration
In 2017/18 the council spent over £145 million Social care and health organisations across
on adult social care and over £11.5 million on Durham have agreed to an ambitious plan to
children’s social care in both the independent further integrate services in the future. Revised
sector and voluntary and community sector. management structures are being established
This figure excludes direct payments, where the and a dedicated Provider Alliance group will
expenditure in this area for 2017/18 was over ensure that provider issues and market factors
£11 million for adults and over £350,000 for are considered throughout the social care and
children. Over £28m has been spent on Public health system.
Health and £15 million on housing related
services in 2017/18. Providers should be aware that partner
organisations will continue to seek opportunities
The council’s Commissioning Service continue to jointly commission services in the future,
to achieve significant savings through service reducing duplication of work and allowing
remodelling; negotiation with existing providers; providers more opportunity to deliver services
and some decommissioning and, where across the whole market. Service users should
appropriate, reinvestment in more efficient not experience different approaches to services
services to better fit future needs. because they are being commissioned by
different organisations and this integrated
The latest Medium Term Financial Plan (MTFP) approach will ensure that resources in Durham
information shows that Durham County Council are delivered in the most efficient, cost effective
will have made £224m savings to 31 March way.
2019, with a further c£35m of savings between
2019/20 and 2022/23. Please see Section 7 – Messages for Providers
of Care and Support to Adults – for more
Continued support for a wide range of information.
preventative services and a transformation
approach in front line children’s services and Supporting the provider market
adult care are helping to ensure that the Durham County Council intends to deliver a
Council’s higher cost social care resources are programme of work in the coming years to
targeted at those most in need. enhance, maintain and support workforce
This approach will continue with the council training, recruitment, retention and development
seeking further opportunities to commission in a number of adult service sectors across
services more efficiently whilst improving provider markets, such as domiciliary/
quality standards and an increased front line community-based care, residential /nursing care,
focus on the development of local community day services and the voluntary sector.
resources, alternatives to traditional resources This work will be funded through the Improved
and supporting the growth of the current Better Care Fund (IBCF) and providers and
reablement, rehabilitation and recovery their priorities will be a key consideration in
approach. planning the programme. This supporting
The council is committed to stimulating a the provider market initiative is designed to
diverse market, where innovation and more be transformative, with an emphasis on new
efficient and effective ways of working are ways of working; including utilisation of new
encouraged and inadequate practice is technology to support improvement.
addressed. We will therefore continue to involve Early examples of interventions linked to this
and engage existing and potential providers work, such as falls training/increased emphasis
and stakeholders to ensure we look for different on falls response; brokerage; and additional
Market
approaches to meet diverse and developingOpportunities
reablement resources, are already benefitting
needs. service users, providers and health and social
care systems across Durham.
9
5. Market Opportunities
The following suggestions are ways providers arranged a Virtual Budget for the individual,
can improve the quality of the services they which he then used to attend bespoke music
deliver: sessions where he was taught how to create
and record his own music. This tied in with his
Working with stakeholders - Involve relevant interests and achieved his identified care plan
council staff, service users and their carers/ outcomes of increasing self-confidence and
family in the design and development of any skills for future employment/volunteering.
services, their feedback is key to improving the
quality of services. Providers need to consider Focus on workforce development –
how feedback can be applied practically to Appropriately trained, qualified and
develop new or improve existing services. competent staff who are well supervised and
managed improves the quality of service
Monitor and review performance – delivered. We have offered Falls Training to
Tracking performance and auditing of key 44 care homes during September – November
areas of service delivery ensures areas 2018, based on those with the highest
for improvement can be identified. This incidence of emergency call-outs (falls being
helps to improve quality, identifying best the major contributor to these). A pilot on
practice and benchmarking with others Sepsis Training is also being undertaken with
ensures learning can be applied, leading 36 staff working in Extra Care, domiciliary care
to service improvement. Clear standards, and Reablement during October 2018 and
consistency and compliance to service if successful, will be rolled out to the wider
delivery expectations ensures quality provider market in early 2019.
assurance. A cycle of plan-do-check-act
ensures improvement is monitored and can be Durham Dales Easington and Sedgefield
demonstrated. Clinical Commissiong Group are also
implementing infection control training with
Review marketing tools used – providers can domiciliary care providers. An update has
promote their service in the most effective been delivered at the Domiciliary Care Forum
places (e.g. Locate which is County Durham’s and arrangements are being made for further
‘emarket place’ www.durhamlocate.org.uk). sessions in the County, with key provider
Consider whether information provided to staff being trained so that they can cascade
people regarding services is accessible and learning to their individual organisations.
easy to understand.
Improving outcomes for people - as
part of the increased focus on quality for
service users, there is a new emphasis by
commissioners in ensuring good quality
outcomes for people. We are looking for
providers who can deliver innovative, flexible
person centred services and, from a broader
point of view, we will expect good providers to
recognise that the people using their services
and their carers are experts in their own lives
and are therefore essential partners in the
design and development of services.
As an example of this new approach, the
council recently assessed a service user Opportunities
Market
with a learning disability who was clear that
he didn’t want to access a day service. We
10Quality Assurance – The Safeguarding Person centred approach
Practice Development Team, commissioners, We want all our services to treat each person
Infection Prevention and Control (IPC) nurses according to their individual care and support
and Care Quality Commission (CQC) work needs and preferences. It is important that
closely together and with providers, having providers adapt their service to deliver flexible
regular information sharing meetings to options and tailored support, particularly as
discuss the quality of locally registered more and more people will be making their
services, agree ways to improve this where own choices in purchasing care utilising their
required and plan how to respond to Personal Budgets and Direct Payments, or as
developing problems. self-funders.
The council’s Commissioning Service will A person centred approach to care and
continue to monitor contracted providers support, will support people to:
to assess the quality of service provision
using relevant evidence-based measures • live independent lives in the way they have
and to ensure contractual compliance. We chosen, based on information about the
will continue to further develop effective options available, and as much involvement
processes for ensuring the quality of services, as they want in decisions about what care
whether or not they are registered with CQC. and support they need and how it should be
We will ensure that Locate continues to delivered.
indicate where a service is CQC registered or • maintain relationships with family and
accredited with the council to help service friends and provide opportunities to take
users make informed choices when they part in community life, including engaging
are choosing a care home or other service, in activities which match their interests,
funding their own care or in receipt of Direct skills and abilities.
Payments.
• live without fear of harm or abuse and
support them to manage any risks which
might arise and to avoid unnecessary risks.
• experience the provision of care positively,
through relationships based on mutual
respect and consideration, and where
care - designed around their needs - is
both consistently delivered and well co-
ordinated with other agencies.
Service user contributions to costs of services There is no reason in principle why these
All Councils who have decided to charge for elements cannot apply to all groups of people
services must follow regulations issued by the needing care and support regardless of the
government. Within County Durham, those setting in which they live, be it a care home,
people who are assessed as being eligible for sheltered housing or their own home. Indeed
social care services may be expected to make it is important that such elements are present
a financial contribution towards the cost of for all people in all circumstances. That is the
those services depending on their financial essence of personalisation – tailoring care
circumstances. Please refer to the council and support to what individuals choose as a
website for further information Paying for your means of helping them to live their normal
care and support - Durham County Council life. People don’t want to be defined by
Not all services are currently chargeable, for their condition – they are not suffering from
example intermediate care, advocacy services dementia or autistic or subject to multiple
and some carer support services. Charging co-morbidities. They are, first and foremost,
Market individuals with very personal hopes, fears,
implications for services will be communicated
Opportunities
to the people who will access them and the aspirations and relationships.
providers that will deliver them.
11Self-funders Voluntary and Community Sector Enterprise
The council expects the number of self- (VCSE)
funders seeking care to increase in the future The council will continue to signpost a number
and has planned for more individuals seeking of people to services in the community
our advice as a result of the Care Act 2014, and an assessment will be made about the
which outlines updated responsibilities for scope and ability of small and medium VCSE
such individuals. The council has a duty to providers to meet this requirement. The role
support those people who choose to fund of the VCSE in combating social inclusion is
some or all of their care and support and increasingly important and VCSE providers
who need non-residential services. In limited across the county will be encouraged to work
circumstances, the council may also choose responsively in their local communities.
to exercise its discretion under the Care Act
to arrange care for self-funders who need VCSE organisations play a key role in the
residential or nursing care. delivery of services, particularly at a time of
major change for the public sector and are
We will continue to develop information and well placed to take advantage of opportunities
improve support and advice on the options and identify new ways of working. The sector
available to self-funders, including potential can become a delivery agent that will ensure
brokerage services. The council also continues the sustainability of vital services across the
to improve and extend its online Locate county by taking a proactive approach. The
adult care information service, which is an council will seek to evolve and strengthen
important tool for self-funders looking for our ethos of partnership working with VSCE
guidance on care services in the County. providers.
Our VCSE Strategy identifies that knowledge
has improved, understanding increased
and productive working relationships have
developed. All partners recognise that a
strong, active and flourishing VCSE is a vital
component in building resilient communities
and enabling individuals to reach their
potential.
Market
Opportunities
126. Working with Durham County Council
Corporate procurement Social value
As a contracting authority the council must The council are fully committed to wider social
adhere to procurement legislation in the form benefits and the environmental wellbeing of
of the Public Contracts Regulations 2015. County Durham and fully embrace the duties
Within this legislation, and relevant to social set out in the Public Services (Social Value) Act
care and health services, are rules that allow 2012.
flexibility in procurement for certain service
contracts in social care, health and education In 2013 Durham was the first local authority
- they allow a Light Touch Regime (LTR) to in the North East to establish its Social Value
be applied to the procurement process. This Task Force. In 2016 the council was a winner
allows us to tailor the procurement to take of the Social Value Leadership Award, and we
into account additional criteria such as the continue to be a committed member of the
market and its development, specific needs National Social Value Task Force.
of the client group, and the involvement and We have applied our social value duties
empowerment of service users. in a wider context than the Act requires,
Further information on how to do business by contributing to the work of the Local
with the council is available: Government Association (LGA), and as
a contributor to the Social Value Portal
Support in using the NEPO ProContract portal in developing a national model for
and more information on public procurement implementation of social value through
legislation (Public Contract Regulations 2015) procurement. This national model considers
is available from corporate.procurement@ opportunities for social value in the design of
durham.gov.uk the procurement process, the specification,
specific clauses, or by the way the evaluation
Information on the procurement process and criteria is applied. An example of this is the
tips for completing a bid, as well as details most recent domiciliary care procurement
of supplier engagement events for large which appointed the majority of providers
procurements, see www.nepo.org from Durham/North East region. This
promoted local economy, business sector
employment through Careers in Care. The
project manager for Supporting the Provider
Market will work with providers to enhance
recruitment/retention and skills in the coming
years.
The council will continue to promote and
embrace the requirements of the Public
Services (Social Value) Act 2012 by pursuing
improvements to Durham’s economic, social
and environmental wellbeing, which are
recognised as the three pillars of sustainable
procurement.
Market
Opportunities
137. Messages for providers of care and support to
adults
The work of DCC Commissioning in relation Teams Around Patients (TAPs)
to adult care and support services will focus This model acknowledges that more care
on a number of key areas: should be delivered in community settings
and at home, through better integration of
Integration of health and social Care provision by a range of staff delivering care
Integration has been a key policy driver for which supports those patients who are most
many years within health and social care. vulnerable and are at risk of deterioration of
Most recently the Five-Year Forward View and their health and wellbeing. The TAPs model
the Care Act 2014 outlined the need to design has an increased focus on prevention and
and implement services around individuals promoting independence by coordinating care
and their communities, to further enhance across the whole range of a person’s health
pathways and joint service provision across and care needs.
health and social care.
TAPs are operational across County Durham,
The NHS locally have already began to principal outcomes include reducing
integrate their commissioning and delivery avoidable hospital admissions, improved
functions, for example the five Clinical out of hospital services, less presentation
Commissioning Groups across Durham, at Accident and Emergency departments,
Darlington and Teesside have a unique improving rehabilitation and Reablement
partnership with Tees Esk and Wear Valley services, reducing the need for permanent
NHS Trust called the Accountable Care residential or nursing care home placements
Partnership, which focuses on integrated and connecting and supporting people better
NHS commissioning in relation to learning in their own communities.
disabilities and mental health.
Joint Strategic Commissioning Function
This way of NHS integrated working makes best An agreement has been reached in principle
use of resources, of the skills and expertise that exploring a Joint Strategic Commissioning
of staff and allows any savings made to be Function would benefit County Durham. This
reinvested into front line patient care. could potentially include the commissioning
of community based services for children
and adults across the County. Acute (hospital
based) and other health care commissioning
is expected to be delivered outside of this
model and would be addressed by CCGs at a
regional/sub-regional level.
An Integrated Care Board (ICB) will be
responsible for driving service development
with partners to ensure that system
integration happens effectively. The ICB will
be a key decision making authority for the
new strategic model of care. Membership will
include leaders from all organisations in the
local health and social care system and the
ICB will act as a forum where whole-system
Market
challenges can be addressed and solutions
identified and initiated. The board will play a
Opportunities
crucial role in the success of new, integrated
14models of care, enabling swift and decisive The commissioning strategy will need to
leadership across multiple organisations, take into account wider work that is being
including both providers and commissioners. undertaken regionally with other local
authorities, CCGs and NHS England as well
Prevention as local partnerships between health, social
We will continue the work with stakeholders care, education, employers, housing, the
on reviewing preventative services to reduce Voluntary and Community sector, police and
or delay the need for statutory care and the Criminal Justice System.
support in order to make social and health
care services more sustainable in the future. The following key principles have been
This aligns with the feedback that we have developed for strategy implementation:
received from individuals about wanting to Co-production - through appropriate service
remain in their own homes for longer. user, carer and provider representatives/
mechanisms
Learning Disability Services
In 2018/19 the council is developing a Joint • Taking a whole-life approach including
Commissioning Strategy for adults and young young people in transition
people (14-25) with learning disabilities, in • A focus on early help, timely intervention
collaboration with health colleagues. This will and prevention
outline our commitment to supporting people
with learning disabilities and helping them • Promoting personalisation and progression
maximise their independence, choice and • Improving outcomes such as increased
control. It will be underpinned by a strategic independence and employment
action plan, which will guide commissioning, • Improving outcomes such as increased
planning and decision making processes. wellbeing, choice and control with shared
Partners will work with local stakeholders responsibilities and community resilience
to agree a shared vision and commissioning
priorities for the future. • Delivering a coordinated approach to
supporting individuals to achieve their goals
Joint commissioning between the CCGs and
the council will be strengthened through • Promoting and developing provider
the best use of resources; more integrated resilience and responsiveness to local
commissioning, contracting, monitoring needs
and reviewing arrangements; and working • Increasing efficiency, cost-effectiveness
together better with service users, carers and and value for money
providers to develop and manage the market.
• Ensuring services are safe and of high quality
Market
Opportunities
15Autism In-house services
An autism action plan is under development The council has recently reviewed and
in 2018/19 to support the implementation of realigned our in-house, County Durham Care
the national Think Autism Strategy in County & Support (CDCS) services. Supported Housing
Durham. A multi-agency Autism Strategy and Reablement services previously provided
Implementation group led by the council is by CDCS will be delivered by the independent
overseeing the action plan with involvement sector in the future.
from key stakeholder representatives. Areas
that will be covered include preventative The council continues to provide Extra Care
support, diagnosis and care pathways, services through CDCS at a range of locations
employment and housing; as well as support across Durham. Pathways Day Services are
for young people in transitions, those with strategically positioned to provide for more
complex needs or whose behaviour may complex, specialist service user groups with
challenge and people with autism in the those who require less intensive services being
criminal justice system. The strategic action placed in the independent sector via the Day
plan will help to identify commissioning Services Panel.
intentions. Current priorities are meeting the The Hawthorn House respite service is in the
Transforming Care agenda and developing process of being reviewed and is likely to also
respite options. accommodate more complex service user
groups in the future.
Mental health
A mental health strategic plan is being The council is also seeking to expand its
developed by Public Health on behalf of the Shared Lives offer, in recognition of the strong
Mental Health Strategic Partnership Board, track record of these services in relation to
a multi-agency/stakeholder group, which improving service user outcomes. The Mental
reports to the County Durham Health and Health Support & Recovery service is also
Wellbeing Board. The five priority areas of being retained in house, with consideration of
the strategic plan are Children and Young the future direction of this service being taken
People’s Mental Health and Wellbeing, forward as part of the wider mental health
Adults Mental Health and Wellbeing, review work, as outlined above.
Suicide Prevention, Crisis Care Concordat
and Dementia. Commissioning plans for Carer Support
mental health will be developed as part of The introduction of the Care Act 2014 has
the different workstreams. This will include seen an increase in the number of carers
the council and partners continuing work asking for support as carers now have a right
on the implementation of the mental to an assessment in their own right even if
health promotion, prevention and wellbeing the person they care for does not have eligible
model, which will involve re-modelling and needs. The council will continue to offer
recommissioning current provision. support to adult carers, including through its
contracts with carer organisations.
Similarly the Children and Families Act 2014
has clarified the law relating to young carers
ensuring the right to an assessment of needs
for support is extended to all young carers
under the age of 18 regardless of who they
care for, what type of care they provide and
how often they provide it.
Residential and nursing care
Market The council continues to work with a range
Opportunities
of residential and nursing providers to deliver
both long and short-term support in care
16home settings. This includes the Intermediate efficiencies which can then support the wider
Care beds model in Durham, where the commissioning activity of social care and
council commissions both ‘step up’ and ‘step health services.
down’ beds for reablement and rehabilitation
purposes for a maximum period of 6 weeks. Information from the recent Adult Social Care
Survey 2017-18 highlighted that the majority
We will continue to engage with the care of service users (88.2%) said the service made
home market to address issues such as the them feel more confident. Most service users
optimum model for nursing services, given the (85.4%) said they were able to do more things
national pressures on the supply of nurses and for themselves after their service ended. The
the potential outcomes from future changes majority of service users (88.7%) said the
in government policy. service helped them to have a better quality
of life. Of the service users that have used the
The council will also work on improving Reablement Service before 89.7% of them
analytical data in relation to the provision of required no ongoing care or had a reduced
residential and nursing care, in recognition of care package going forward.
the challenges faced by both Local Authorities
and providers in terms of predicting future Comments such as “The service was a real
need and where and how resources should be bonus for me to be able to remain in my own
directed. home”, indicate that the service is working
well.
Domiciliary care
A review of domiciliary care services will Day care services
report in late 2018 and will be followed by A provider panel for day care will be
a procurement process to re-commission commissioned on a yearly basis to allow new
domiciliary care services from 1st April providers to come onto the day care approved
2019. The review will consider if any framework. The Council intends to work with
strategic changes are required to the current day services providers to increase innovation
domiciliary care framework and/or spot in these services, including identifying
commissioning arrangements. service users with aspirations to move into
volunteering or paid work in the future, in line
The council recognises the key role which with transforming care principles.
domiciliary care plays in supporting people to
remain in their own home and assist hospital
discharge alongside wider health services.
The review will consider the optimum ways of
ensuring that domiciliary services are robust
in terms of their ability to deliver high quality
interventions in the future.
Reablement services
Reablement is a key community service which
plays a critical role in helping individuals to
recover and regain independence following,
for example, a stay in hospital.
The council has a dedicated, countywide,
Reablement service in place and as well as
seeking to increase the usage of this service,
will also explore the potential of using
reablement principles in the delivery of other
provisions, either existing or new. As well Market
as benefiting individuals in terms of their Opportunities
own wellbeing, Reablement also generates
178. Messages to providers for children’s services
We want County Durham to be a great place • And achieve the best possible outcomes
for children and young people to grow up for children and young people with special
in and for Durham to be a place where all educational needs and disabilities (SEND)
children are healthy, happy, and achieving
their potential. Commissioned providers play a key role
in helping us deliver these outcomes for
Our key aims are to ensure: individual children and young people.
• Children and young people have a safe Durham County Council remain committed
childhood to securing the participation of children and
• Children and young people enjoy the best their families to enable them to influence
start in life, good health and emotional decisions about their lives and the design and
wellbeing delivery of services that leads to change.
• Children and young people can access We believe that children and young people
good quality education, training and local that are looked after and/or children and
employment young people who have special educational
needs and disabilities have the right to the
same outcomes as every child in County
Durham to ensure that Durham is a place
where all children are healthy, happy, and
achieving their potential.
There are different degrees of participation
but where possible Durham County Council
and partners will strive to co-produce
services with children, young people and
their families.
Co-production is a way of working that
ensures people who use services are involved
in an equal partnership. Co-production places
an emphasis on engaging groups of people
at the earliest stages of service design,
development and evaluation. Co-production
acknowledges that people with lived
experience of a particular condition are often
best placed to advise on what support and
services will make a positive difference to
their lives. Done well, co-production helps to
ground discussions in reality and to maintain
a person-centered perspective.
For co-production to become part of the way we work, we will create a culture where the
following values and behaviours are the norm:
Ownership, A commitment
A culture in
understanding A culture of to sharing Clear
which people
and support of openness and power and communication
Market are valued and
co-production honesty decisions
Opportunitieswith in plain English
respected
by all citizens
18Children and young people have a safe Children’s residential services
childhood Durham’s agreed route to seek external
The council works collaboratively with residential provision for children is through
families and partners to offer family support the new regional flexible solution called the
and enable children and young people to be North East 12 Consortia Framework which
cared for within their own families wherever commenced on the 1st February 2018. This
possible. We offer a range of Early Help enables the council to purchase children’s
Services to support children and their families, residential home placements and for
and prevent entry into care. children and young people from independent
providers.
When it is not possible for a child or young
person to remain with their family, we will An analysis of need highlights that there
seek to provide high quality care which meets remains insufficient residential provision
their individual needs, as near as possible to to meet the current and future needs
the child or young person’s home to maintain of our looked after children and young
links with birth parents, relatives and their people. Particularly in relation to children
communities (where appropriate). with complex needs and behaviour that
challenges who require solo provision to
Independent fostering support discharge arrangements and bail
Alongside our own fostering and residential conditions. There remains a pressing need
arrangements we make placements with to develop provision that has the capacity
independent fostering agencies (IFA’s) and to provide a broader and more flexible
independent children’s residential homes and accessible range of quality residential
where this may be necessary to meet the solutions which ensures that the needs of our
child’s needs. Durham plays an active role most challenging and complex children/young
in the current North East 7 IFA Consortia people are met.
Framework, which enables independent foster
placements to be purchased from providers. Care leavers
This is an established framework in its second As Corporate Parents we want to give care
phase which has received positive feedback in leavers every opportunity to be happy,
national reports. healthy and safe and to achieve their full
potential. It is important that their transition
The current framework is due to end in March into adulthood is positive and that all
2019. A new commissioning solution is young people have the necessary life-skills,
being developed involving 12 regional Local confidence and experience to enable them
Authorities. It is anticipated that this regional to thrive. Young people leaving care need
approach will result in greater understanding somewhere safe and suitable to live to
and input into the recruitment strategies help them make a positive transition into
of IFAs and a consistent approach to the adulthood. Good housing underpins success in
commissioning of IFA placements across other areas of life.
the region. The new solution will also offer a
greater level of flexibility, enabling new IFAs The council has historically worked with the
to join (following relevant checks) throughout provider market to develop a menu of options
the term of the contract. to meet the accommodation needs of care
leavers which are accessed on a spot purchase
basis. The introduction of new legislation in
April 2018 that requires Local Authorities to
secure support and accommodation for care
leavers up to the age of 25 will result in an
increase in the need for accommodation and
Market support options for the 21-25 age group. An
analysis of need further highlights that there
Opportunities
is a growth in demand for supported living
19more generally (16-25 years), with a need to The 5-19 service
consider support and accommodation options Provides a service to all children and young
for young people released from custodial people of school age, and their families,
settings. In response, there will be a need to whether or not they are attending school.
increase the number of accommodation and The service offers advice and information,
support options for Care Leavers across the and assesses the health needs on children
county. entering school and on transfer to secondary
schools. The service is the first point of contact
Children and young people enjoy the best for schools when there are concerns about a
start in life, good health and emotional child’s health and wellbeing.
wellbeing
We want every child to have the best start in These services are scheduled to be
life and ensure that this continues throughout recommissioned in early 2020. Going forward
their childhood through the promotion of it is anticipated that there will be further
good health and emotional wellbeing. Healthy emphasis placed on the integration of
and resilient children are ready to learn, ready health, education and care services across
for school and have good life chances. communities to secure the best start in life,
good health and emotional wellbeing for
County Durham’s Healthy Child Programme children, young people and their families.
This initiative is a commissioned public
health programme for children, young Children’s mental health services
people and families which focuses on early Mental health problems in children and
intervention and prevention. The service works young people are common and account for
in community settings to deliver universal a significant proportion of the burden of
and targeted interventions designed to ill-health in this age range, with estimates
meet public health outcomes to secure the suggesting that mental health problems affect
emotional and physical health and wellbeing approximately one in ten. Durham County
of babies, children, young people and Council and partners continue to consider
families across County Durham. The service ways to make it easier for children and young
is delivered in partnership with a range of people, their parents and carers to access help
health, social and education organisations. and support when needed.
The 0-5 service The council and the CCGs jointly commission
Offers a programme a suite of preventative mental health services
of screening tests, including:
immunisations, • Children and Young People’s Bereavement
developmental Support Service which provides easily
reviews, information accessible and culturally appropriate post
and guidance to intervention and bereavement counselling
support parenting and support for the children and young
and healthy lifestyle people in County Durham.
choices. All families
with a child under five in County Durham • Suicide Prevention Helpline which provides
have access to the community-based service confidential practical advice and support
which consists of Health Visitors, Early to children and young people who are
Years and Assistant Practitioners and infant experiencing suicidal thoughts and finding
feeding specialists. They provide expert life difficult; and also offers advice to
health assessments, advice, support and those who may be concerned about a
interventions for babies, children and families young person who they feel may be having
and encourages and supports parents and thoughts of suicide.
carers to develop life-long skills to enable Market • Parental Peer Support Service which
Opportunities
them to make informed choices that affect provides parent support groups in County
their family’s future health and wellbeing. Durham, one in the South and one in
20the North for parents with experience of changing attitudes of individuals who have
supporting a child with emotional and perpetrated domestic abuse.
mental health problems.
Children and young people can access
Existing contracts are due to expire in January good quality education, training and local
2019 therefore, we are currently working to employment
review a wide range of preventative Mental All pupils should be helped and encouraged
Health services with procurement scheduled to achieve or exceed the standards of a good
to commence November 2018 with new education. To support learners who, because
services in place from February 2019. In of exclusion, illness or other reasons, would
addition, we are currently engaging with not otherwise receive suitable education,
Children and Young People with a view to schools have the power to secure alternative
developing a “Digital Offer” aimed at early education that is tailored to the young
intervention of Mental Health issues via on- person’s needs.
line support and self-help tools.
Education placements
Domestic abuse services Alternative education placements can vary
Tackling domestic abuse continues to be a from academic placements with colleges
key priority for the Council and the broader to vocational placements encouraging a
Safe Durham Partnership. Domestic abuse more ‘hands on approach’ or therapeutic
can seriously harm children and young people placements like counselling or developing
whether they are abused directly by the confidence and social skills.
perpetrators and by hearing, witnessing or
intervening in incidents. Witnessing domestic We have high expectations for all young
abuse is child abuse, and teenagers can suffer people who live in County Durham. We want
domestic abuse in their relationships. to ensure that they have access to appropriate
education, in a safe learning environment
The council commission a countywide and are given the opportunity to gain and
Domestic Abuse Service. The service delivery develop skills to help them progress, learn
model places a significant emphasis upon and develop. To support the development of
integration with social care teams and seeks high quality alternative education the Council
to provide: manages a directory of alternative education
providers for schools to access when
• Individual practical and emotional support considering placing a pupil on an alternative
to victims of domestic abuse aged 16 years provision. This directory provides schools with
and over in a variety of formats to meet the information on those providers who have been
needs of the victim including face to face quality checked and monitored to make sure
1:1 sessions or over the telephone; they meet minimum standards.
• Individual support to children and young Businesses or organisations that become
people aged up to 17 years who witness providers of alternative education and offer
domestic abuse in a range of settings placements will receive funding from schools
including group work and 1:1, meeting the for each student placed. If you want to make
needs of the individual. a difference and become a recommended
These services are scheduled to be provider of alternative education in County
recommissioned in autumn 2018. Going Durham you will need to register your interest.
forward it is anticipated that there will be Completion of the Alternative Education
further emphasis placed on the integration Directory application form and Provider self-
of domestic abuse services to improve the assessment form available at www.durham.
health, wellbeing and safety of victims who gov.uk/alternativeeducation.
have experienced domestic abuse and the
Market We have a commitment to supporting
safety of children who have witnessed Opportunitiesproviders and will provide training
domestic abuse; whilst challenging and opportunities which can be accessed by
21alternative providers to support workforce and value for money’ and positive outcomes for
organisational awareness and development. children and young people enabling them to
live independent, safe and active lives.
Achieve the best possible outcomes for
children and young people with special These services are scheduled to be
educational needs and disabilities (SEND). recommissioned in autumn 2018.
In County Durham, we want all children Providers providing personal care at any
and young people (0-25 years) with special time must be registered with the Care
educational needs and/ or disabilities (SEND) Quality Commission (CQC) for the provision
to be given every opportunity to take control of Domiciliary Care Services. Services will be
of their lives, be as independent as possible available twenty four hours per day, seven
and achieve their full potential in life. days per week, and three hundred and
sixty five days per year, flexible, timely and
SEND services speedily accessed. They may be required in
We will focus attention on services which an emergency situation with 24 hours’ notice
prevent, delay or reduce needs from or for a brief period of time; in addition to
escalating, working alongside our families to requirements for long-term care to service
focus on maximising inclusion, confidence and users within their own homes to prevent
independence. This will require a co-ordinated, unnecessary admission to hospital or
personalised, creative and flexible approach to children’s residential care facilities.
providing services.
For further information contact:
Going forward the council and the CCGs will be
seeking to build upon the recent reviews of: Strategic leads for commissioning within Adult
and Health Services and Children and Young
• Paediatric Therapy Services People’s Services are shown below:
• Autism (including Social Communication • Neil Jarvis – Interim Strategic
Assessments) Commissioning Manager Older People /
• High Needs Educational Provision Physical Disability and Sensory Impairment
To inform the recommissioning of services Services
education, health and care services. • Tricia Reed – Interim Strategic
Commissioning Manager Learning Disability
and Mental Health Services
• Mark Smith – Strategic Commissioning
Manager Children and Young People’s
Services and Public Health
Children’s domiciliary care services
Enable children and young people to live
within their own home and community while
preserving maximum independence and
quality of life. The Council is committed to
the delivery of high quality Domiciliary Care
Services and wishes to work in partnership Market Contact strategic commissioning managers
with providers, who can demonstrate and Opportunities on ahs.commissioning@durham.gov.uk or
deliver services which achieve and maintain by telephone on 03000 266 837
229. Key Messages from Public Health
Durham County Council aims to improve Every child to have the best start in life
and protect the health of local people and Give our children the best start in life by
reduce the unacceptable differences in commissioning high quality 0-5 health visiting
health inequalities that continue to exist. services, reducing smoking in pregnancy
and childhood obesity, and by improving
Combining the needs identified in the breastfeeding and emotional health &
Joint Strategic Needs Assessment; the wellbeing.
requirements of the mandated services for
local government; the data provided via Excellent drug and alcohol provision
the local Health Profiles; as well as local • Reduce the harm from alcohol.
knowledge about services and assets in our
communities; means that in order to achieve Mental health at scale
the Public Health Vision, we need to focus on • Support the County Durham Partnership
the following key areas: Prevention at scale – mental health.
Good jobs and places to live, learn and play • Improve mental wellbeing for all ages
• Develop opportunities for good including suicide prevention and reducing
employment loneliness.
• Reduce poverty
Our healthy workforce
• Encourage inclusive growth, employment, • Develop the wider public health workforce
education and skills via Making Every Contact Count (MECC).
• Ensure good homes for everyone
Better quality of life through integrated
• Develop a community led approach and health and care services
help to build connected and resilient • Reduce the morbidity and improve quality
communities. of life for those with long term conditions
including cancer, CardioVascular Disease
(CVD) and respiratory conditions.
Every child to
have the best
start in life Positive behaviour change – smoking,
Good jobs and
Mental health activity and food
places to live,
learn and play
at scale • Work towards a smoke free future for our
children and families.
• Carry out dedicated interventions with
targeted populations including Gypsy
High quality Promoting Roma Travellers (GRT), those most at risk of
drug and alcohol
services
positive
behaviours
domestic abuse, drug & alcohol misuse and
sexual health.
• Tackling obesity (sedentary behaviour and
poor food consumption).
Better quality
of life through
Healthy
integrated
workforce
health and care
services
Market
Opportunities
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